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Faced to reduce from quints...

We tried for two years to become pregnant and now we are pregnant after IUI injectable cycle with quintuplets... I am a very small frame person and our doctor as advised us to reduce from 5 to 3 in order to bring home healthy babies and have a healthy mom! My doctor said she would be comfortable with me having triplets but my husband is scared and wants twins instead. I am torn, one day triplets don't sound so scary and then the next day I am scared to death and don't think I can do triplets... We are only 7 weeks pregnant right now and the reduction won't happen until 10 or 11 weeks. SO we have three weeks....

Congratulations on your pregnancy. I'm sorry it's coming with such a difficult decision/thing to do. You have asked a very difficult question and it's one that only you, your spouse and your doctors can answer. However, it is good to seek advice from people who have been there (on both the positive and negative side of things) and make the best decision you can for you and your family.

Many people feel that triplets are now "common place" but they are considered a higher order multiple (HOM) pregnancy and with that comes added risks, including but not limited to pregnancy complications that can (and often does) lead to modified bedrest/bedrest, medical intervention and early delivery (the average gestational age for triplets is not 38-40 weeks, I believe it's 32-34 weeks). Many triplets spend time in the NICU (neonatal intensive care unit) after delivery and often times, one, two or all of the triplets will have short term medical and developmental issues and sometimes long term/permanent developmental and/or medical issues.

Is your doctor a perinatologist (high risk specialist)? Here are some questions I would ask her:

Will she do a CVS (invasive) or First Trimester Scan (non-invasive) on the fetuses to make sure that you do not-not reduce an unhealthy fetus. (We did a first tri scan on one fetus and when that was clear, we reduced the others).

Why does she reccomend reducing from 5 to 3 instead of 5 to 2? What are the health risks/complications in having a HOM triplet pg compaired to a twin pg? Are there any medical benefits in reducing from 5 to 3? what about 5 to 2?

What preventative measures (if any) will she take to help the pg? (Will you have more frequent ultrasounds? Will she check your cervix on a regular basis to look for preterm changes?) And what measures will she take if you should develop complications? (What medications will they use? At what point would they admit you to the hospital if bedrest is required?)

You asked "what would you do" and I will share with you both my expereinces when I faced redcution (twice). The first time, I concieved fraternal triplets through in-vitro fertilization. We transfered 3 embryos and all 3 took. I started researching triplet pregnancies, talked with numerous doctors about reducing vs keeping them, talked to other triplet moms (all of whom had "sucessful" pgs, many of whose triplets were born at 32-34+ weeks). I found out I was an "ideal" candidate for a triplet pg (5'8", in great shape, healthy, etc). I sub-consciously avoided people who had less then opitmal outcomes (ie-their children had more severe disabilities) and ultimately, I decided to keep the pg as it was and carry the triplets. Unfortunately, even with them best medical care, a lot of medications, strict bedrest and doing everything in my power to give my babies the best chance, they were born too early and all three of them died shortly after their births. It was the most devasting thing I have ever been through in my life.

My next triplet pg was on a 2 embryo transfer and one split so I was pg with identical twins and a singleton. I absolutely couldn't believe I was pg with triplets again and I cried daily. I knew I would reduce and the question became to reduce from 3 to 1 or 3 to 2.

Again, I did research, I talked to doctors and I thought and thought about what to do. I knew if I had complications, they would be easier to take care of if it was a singleton pg and I knew that my best chances of bringing home a healthy baby was with a singleton. I ended up reducing the identical twins and carried my singleton. She is now a completely trypical, healthy 4 year old child.

I am by no means saying that you should reduce from 5 to 1. I don't think that's what I would have done-even had I already lost Hannah, Ryan and Abby (the triplets I gave birth to). But the medical truth is that your best chance of bringing home healthy babies is by carrying less. Twins are higher risk than a singleton but triplets are higher risk than twins. I would want to give myself the best chances of bringing home healthy babies and I think that your chances of doing so would be better with twins than with triplets. So, I would reduce to twins.

Sorry if I muddled your thoughts and feelings. I can't seperate my own expereince and be unbaised about it. I don't regret my decision to carry Hannah, Ryan and Abby, even though they died-but that was beceause I held them, loved them and knew them, even though it was brief. However, when I was faced with the situation again, I made a different decision because a triplet pg is a high risk pg and ultimately, my goal in going through infertility treatments was not to "just" get pregnant-it was to get pregnant and bring a baby home with me to raise.

I hope that helps and I wish you the best of luck with your decision and your pg.

April
Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
== A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.

I personally would go to twins. Luckily we were only faced with 3 to 2 to begin with (also after TTC for 2 years with 2 losses and then IUI + injectables), but had the situation been different I still would've gone to twins. In my opinion (and my doctor's) there are still just too many risks with triplets. I wanted to bring home HEALTHY babies and it is much harder to do that with triplets. Only you or your husband can decide & whatever you decide will be best for you. Good luck and keep us posted!

I reduced to twins (from 4 to 2) but often I wonder if I should have reduced to triplets....it's a really difficult choice but the statistics and doctors are good with twins...triplets more riskier...it really has to be your choice. I got 3 doctors opinions and did alot of research....my pregnancy was really good...reached 36 weeks. The goal is to be pregnant for as long as possible so you can bring home healthy babies. Babies born 25-30 weeks have a chance to be disabled and I didn't want to take this chance.

Congratulations on you pregnancy. I know this is a difficult decision. I just had my reduction yesterday. I went from 3 to 2. We researched the risk of a triplet pregnancy vs a twin one and decided that twins was the best for us. We were very concerned about the possible health issues of triplets.

I felt the same as you. One day I thought I could raise triplets, the next I couldnt imagine how I would do it. But, ultimately, I knew we could only handle twins at this time.

I wish you a healthy pregnancy and healthy babies whatever your decision.

I am quite biased, because I've had problem pregnancies and a premature child with some developemental delays. I also had a nephew born with cerebral palsy and other problems who died when he was 3 months old. As a result, I try to minimize risks. My goal is not only to bring a live baby home, but to bring a healty normal baby home. Once you've had things go wrong with pregnancies multiple times, it is hard to be optimistic and hope for the best.

Your OB may have better numbers, but Wikipedia states that 91% of triplets are born preterm, 41% of triplets are born "very preterm". Only 14% of twins are "very preterm". Very preterm babies can have long term problems. 4.5% of triplets have cerebral palsy (which means the chances of having at least one triplet with cerebral palsy is 13.5%). This is too much risk for me, I could not deal with a scenario in which I end up with triplets with special needs. That being said, some women do have healthy triplets.

You never know what will happen, and unfortunately have to make this horrible decision. I do not know what are the odds for triplets to be born completely normal are, and I do not know what kind of risks you are willing to take. Your doctor is comfortable with triplets even if you are small framed, your husband not so much. Have you talked to the peri that will do your reduction? Maybe you can try to schedule an earlier consultation.

There is no right answer, but there is no wrong answer either.

It is very hard, but you'll get past this. And whatever you decide, you will find peace with the decision.

Thank you all for sharing your stories. We have about ten days to make our choice and my thoughts are going crazy each passing day. I already have one child and that pregnancy was very easy and uneventful. I'm 5'9" and a healthy 140lbs so that is why my doctor seems to think I could carry triplets to term (34 weeks). Still just not sure...

mame2abe...if your doctor thinks you can carry triplets and you are comfortable...go for it !!! I was 5'5" and 125 pounds so my doctors thought I was on the smaller side therefore recommended twins...but I read in a book that if you are a bigger size, then you have a much better chance....although I have a friend who is very tiny and she carried triplets quite well....I guess we are all different.

I got another opinion from our RE and also a few experienced nurses and they all seem to be in agreement that I would or should be able to have a pretty uneventful triplet pregnancy! We go next week for the reduction and we will then also consider the opinion of the Perinatologist. At this point I think I would regret not going to three...

Weather or not the risk of CVS is worth it is different for everyone. I really depends on your age, your family history, and how experienced you peri is.

The risks for CVS vary tremendously depending on the skill of the physician and the number of punctures you'll need. I wrote this in another post: for my first pregnancy I was 32 and had no reason to be worried; it did not even cross my mind to do a CVS or an amnio. 6 years and many problems later I absolutely wanted to do CVS on both my placentas. One of the results was abnormal.

Again, talk it over with your Drs, in particular your Peri.

I do not want to dissuade you from carrying triplets, but I do want to tell you something that happened to me. I delivered my son 6 years ago prematurely. When I started infertility treatments later to concieve my second, I had a consultation with the Maternal Fetal Medicine group, because I wanted to avoid reduction and I wanted a medical opinion about wether or not I could carry multiples. I was told that for sure I should not carry triplets, but the head of MFM said he'd be comfortable with me carrying twins. I knew that this was not the case. I had this strong instinct that my body was not made for twins, no matter what the Drs said. I reduced a twin pregnancy. I am almost 34 weeks now. And I know without a doubt that I did the right thing. This (now singleton) pregnancy has been very complicated, I am on modifyied activity and non-stress test 2x weeks and my cervix is thinning, etc. I am 5'6" 110lbs.

Listen to the Drs, but listen to your own body too. It sort of sounds like your mind is made up, which is great! Once a path is chosen, things start getting easier.

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